First Aid for the Soul: Providing Psychosocial Care Following a Mass Casualty Incident

By Laurie Pearce

On September 13, 2006, there was a shooting at Dawson College in Montreal. One student was killed and many were critically injured before police arrived and the shooter took his own life. Many of those who witnessed the events were undoubtedly traumatized and waited for hours to be interviewed.

In the wake of numerous mass casualty incidents (MCIs) throughout Canada, including the 2013 Lac Mégantic rail disaster, which left 47 dead, and the 2011 Stanley Cup Riots in Vancouver, which resulted in 144 people needing hospital care, emergency managers are exploring how to address the human factor following such incidents. How were victims and responders supported following these events? What services were available to witnesses and bystanders? How were families reunited with their loved ones?

Exercise Target Red was developed to address the concerns that arise for those affected during MCIs, which are large-scale events involving multiple deaths or injuries. As a part of the Simulation, Training and Exercise Collaboratory (SIMTEC) project, this exercise focused on best practices for those psychosocially impacted by MCIs, particularly criminal events. SIMTEC is a four-year research project funded by the Canadian Safety and Security Program (CSSP), undertaken by the Justice Institute of British Columbia (JIBC), championed by Health Canada, and in collaboration with Royal Roads University. Exercise Target Red is an active-shooter functional tabletop exercise, which was posted recently on the SIMTEC website for incident command teams to test and practice integrating psychosocial awareness into existing response protocols.

“Investing in the psychosocial health of the responder before, during and after a mass casualty event ensures a long and healthy career of our greatest assets in mitigating the impacts of a mass casualty event,” said Rod Salem, Director, Emergency Management Special Operations for the British Columbia Ambulance Service.

“First responder personnel have a duty formally placed upon them to rescue, find safety and start the recovery process for victims,” said Wendy Van Tongeren, retired BC crown prosecutor. “Police of course have an added duty to gather evidence for the anticipated legal process. Psychological first aid is the strategy integral to moving a victim from emotional crisis to safety, from emotional injury to recovery and can be properly administered without inappropriately influencing recall of the event,” added Ms. Van Tongeren.

Our research team, supported by our Expert Working Group, which included police personnel, conducted extensive research into the most appropriate protocols for providing psychosocial care to victims and witnesses, their family and friends, and first responders in an MCI. The research found that the immediate and long-term emotional responses associated with MCIs are reduced when people are provided psychological and social support early on, during, and after an incident.

Given these results, the team created a number of training resources. A training and awareness video provides incident site commanders and other first responders with concrete strategies for managing and calming MCI victims and casualties.

A wide range of pamphlets provides information on topics such as: psychological first aid; family assistance centres; first responder self-care; tips for police on interviewing witnesses, and resources for victims: http://simtec.jibc.ca/node/127

The exercise release generated much attention, particularly given its focus on providing opportunities for first responders, witnesses, casualties and others to reunite following an MCI. Given this interest, in March 2015, the SIMTEC team invited individuals from cross-sectoral organizations to participate in a workshop to explore implementing policies across BC and Canada that could support reunification of all affected individuals following an MCI. It was very successful and a report on our results and strategies for moving forward can also be found on the SIMTEC website: http://simtec.jibc.ca/

Laurie Pearce is the Research Chair at the Justice Institute of British Columbia and an Associate Faculty member at Royal Roads University. Laurie has specialized in disaster management and traumatic stress for over 25 years. She is a member of the World Association of Disaster and Emergency Medicine, the Association of Traumatic Stress Specialists, and the International Disaster Sociological Association. She also sits on Canada’s National Platform for Disaster Risk Reduction Advisory Committee.

The third Canada-United States (U.S.) Enhanced Resiliency Experiment, known as CAUSE III, took place in November 2014. The CAUSE series is a collaborative effort between Defence Research and Development Canada’s Centre for Security Science (DRDC CSS), Public Safety Canada and the U.S. Department of Homeland Security Science and Technology Directorate (DHS S&T), in partnership with various provincial, state, municipal and non-governmental organizations.

SCENARIOS

The objective of CAUSE III was to measure the resilience impact of interoperable technologies during multi-agency cross-border emergency responses and recovery operations. The experiment was comprised of two disaster scenarios – the first being a major weather event (“Hurricane Kelly”) affecting the Northeastern U.S. and the Halifax region of Nova Scotia; and the second, a brush fire in the Western Plains, affecting Alberta, Saskatchewan and Montana.

The Northeastern scenario involved collaboration between emergency management agencies in Nova Scotia and New Hampshire and digital volunteers1 to test officials’ capability to leverage social media. The Western scenario involved collaboration among emergency management agencies in Alberta, Saskatchewan and Montana to assess land mobile radio (LMR) and 700 MHz public safety broadband Long Term Evolution (LTE) technologies for emergency communications.

#SMEM: SOCIAL MEDIA IN EMERGENCY MANAGEMENT

A simulated environment was created for the experiment to allow the use of social media in concert with situational awareness tools. These tools helped support the exchange of alerts, warnings and notifications and the coordination of mutual aid between Canada and the U.S. Many emergency management organizations have recognized that information sharing and engagement on social networks is critical to crisis response, disaster relief and community recovery, and they continue to refine and deepen their online community engagement. Jason Cameron, from the Calgary Emergency Management Agency (CEMA), summarizes his social media for emergency management approach in this way: “The more you can share, the more resilient you are.”

However, capacity and lack of expertise are two frequent barriers in the effective application of social media in emergency management (SMEM), particularly in smaller municipalities with limited resources. The CAUSE experiment allowed participants to learn about social media practices and opportunities, refine internal processes, and identify existing and potential barriers. It demonstrated that digital volunteers, including Virtual Operations Support Teams (VOSTs)2, can be a valuable resource for providing ‘surge capacity’ to extract situational awareness from social media during disasters. The experiment made a significant contribution towards advancing the field of social media in emergency management and digital volunteering in both the U.S. and Canada.

CAUSE III WEST EXPERIMENT

In the Western scenario, a large simulated brush fire spanning Saskatchewan, Alberta and Montana and requiring a multi-jurisdictional response was used to demonstrate enhanced situational awareness through improved wireless communications interoperability and the use of feature-rich data applications.

On the first day of the experiment, three distinct LMR systems were used to provide voice communications to emergency response teams on both sides of the border. Communications were further improved by incorporating an LMR interoperability gateway that allowed responders on all three systems to talk to one another.

On the second day, high speed Long-Term Evolution (LTE) was used to allow all emergency responders from the three jurisdictions to communicate and share valuable situational awareness information over the Internet. In doing so, it was discovered that information analysis and response times were significantly reduced, and operational efficiency increased as compared to the voice-only communications on day one.

INTEROPERABILITY ENHANCING WIRELESS COMMUNICATIONS

Efficient cross border communication is key. The LTE capability allowed operators to use laptops, tablets and smart phones for voice and video conferencing, streaming video, and to send and receive real-time interactive maps, pictures and emails to facilitate information exchange.

Duane McKay, the Fire Commissioner for the province of Saskatchewan summed up the value of the experiment as such: “Disasters such as wildfires and floods do not simply follow the borders on a map, which is why experiments like this are so valuable. It is important that jurisdictional neighbours work together through initiatives like CAUSE to increase awareness and provide our communities and residents with the best possible information and response when faced with an emergency.”

The experiment was a significant first step in moving towards improved, interoperable wireless communications between Canada and the U.S. in response to cross-border emergencies.

For more detailed information on the experiments, including findings and recommendations, check out the CAUSE Northeast report here and be on the lookout for the CAUSE West report, which will be released in the next few months. The success of the CAUSE series of experiments has led to a high level of interest in both Canada and the U.S. to consider follow-on experiments in order to add to the great lessons learned so far. Stay tuned!

Kate Kaminska is a Research Analyst at DRDC CSS.

Joe Fournier is Portfolio Manager, Wireless Technologies at DRDC CSS.

Major International Exercise: Four Countries Demonstrate Chemical, Biological and Radiological (CBR) Response Capabilities

By Carey Larsson

From April 27 to May 1, 2015, more than 300 military and law enforcement personnel, explosives technicians, forensic experts, firefighters, paramedics, scientists and other experts from Australia, Canada, the United Kingdom, and the United States visited the Nation’s capital to participate in a capability exercise commonly referred to as CAPEX. The CAPEX events are organized under the auspices of a quadrilateral arrangement between the four countries to coordinate efforts, exchange information, and identify best practices to counter chemical, biological, and radiological (CBR) terrorism. Through this arrangement, a number of aspects are examined by various working groups with a specific focus on the science and technology elements. One of these groups, the Technical Response Group (TRG), is responsible for planning CAPEX, which is held on a biennial basis with hosting responsibilities rotating between each of the four countries every two years.

CAPEX 2015, or “Exercise Northern Lights”, was co-led by Defence Research and Development Canada’s Centre for Security Science (DRDC CSS) and the Royal Canadian Mounted Police (RCMP), with exercise planning and support provided by Industry partner International Safety Research. Funding for the exercise was provided through the Canadian Safety and Security Program (CSSP), with additional monetary and in-kind contributions from participants in the form of employee hours, travel expenses and equipment.

“Our involvement in the CAPEX events is driven by the recognition that collaborating with our international allies and partners is necessary to avoid duplication of effort, draw on best practices, and benefit from investments already undertaken,” said Mark Williamson, Director General of DRDC CSS. “In addition, the CAPEX exercises are a key input informing the CSSP investment priorities through the identification of scientific and technological gaps related to CBR response.”

The theme of the exercise, ‘Crime-scene to Courtroom’, reflected a focus on demonstrating how each country’s response to a CBR event includes identifying and gathering information and intelligence to assist investigators in capturing and prosecuting those responsible. CAPEX takes place in a full-scale field exercise environment with response teams from each country participating in three relevant scenarios, focused around CBR threats. “Operators and practitioners from the four countries see CAPEX as an opportunity to work together to improve interoperability, identify new technology needs, compare equipment and operational procedures, and share operational and scientific knowledge”, said Bob Henstridge from the United Kingdom who is the TRG Co-Chair and UK lead Exercise Planner.

Canada’s team included personnel from the National Chemical, Biological, Radiological, Nuclear, and Explosives (CBRNE) Response Team, which is made up of RCMP explosives and forensic specialists, the Canadian Armed Forces’ specialist CBRNE team called the Canadian Joint Incident Response Unit (CJIRU), and biological experts from the Public Health Agency of Canada (PHAC), as well as chemical experts from DRDC’s Suffield Research Centre and Environment Canada, and radiological experts from DRDC’s Ottawa Research Centre and the Directorate of Nuclear Safety within the Department of National Defence.

“The CAPEX exercises provide a unique opportunity for an international peer review of our response procedures by our allies,” said Inspector Ken Faulkner, Officer in Charge of CBRNE Operations at the RCMP. “This ensures that we are constantly improving Canada’s ability to respond to these infrequent but high-impact events.”

A Full Program of Activities

In addition to each team responding to three different scenarios, they also attended demonstrations of up-and-coming technologies related to CBR response. The technologies demonstrated were: the Compton Gamma Imager developed with CSSP support by the National Research Council (NRC), Natural Resources Canada (NRCan) and McGill University; the CSSP-sponsored CBRNE Crime Scene Modeler (C2SM) and its more recent incarnation known as “enhanced perception of CBRNE Hazards” (EPOCH) developed by

MacDonald, Dettwiler and Associates Ltd, RCMP, and DRDC; the explosives blast modelling tool called the Rapid City Planner developed with CSSP support by DRDC and Martec Limited; and the prototype Low Burden Individual Protective Equipment (IPE) developed by DRDC. These demonstrations were hosted by NRC and provided responders with insight into new capabilities that could impact their response to a CBR event while also providing an opportunity to give important operational feedback or identify potential collaborative opportunities to leverage investments.

The CAPEX event also included a Visitors Day for invited guests from across the Canadian government, as well as for diplomatic personnel and other visitors from the participating countries. This event allowed visitors and participants to learn about the capabilities of participating nations by rotating through the base camps of each country to view their equipment displays and discuss the CAPEX event. A scripted scenario was also presented, highlighting a four-country collaborative response to a scenario to give observers a snapshot of what a CBR response entails.

The exercise was a resounding success for all involved and provided an opportunity to identify several potential collaborative activities that could be undertaken by the four nations through the TRG. With the completion of CAPEX 2015, Canada passes the lead to Australia for planning and execution of the next round of TRG and CAPEX activities. Canada’s continued participation in this forum provides an invaluable opportunity to exchange information, identify new areas of work and leverage investments in the area of CBR counter-terrorism with our allies.

Carey Larsson is Section Head, Threats and Hazards, at Defence Research and Development Canada’s Centre for Security Science.

Novel DNA technologies can help protect Canadians from plant pathogens and pests

By C. André Lévesque

Plant pathogens might not be what first comes to mind when thinking about public safety and security, but there are several plant disease agents, or pests, that can cause significant disturbances to the Canadian economy and public health. Major epidemics can completely decimate crops from farm land or trees from urban landscape. The potato famine in Ireland in the

mid-1800s was caused by a plant pathogen and the recent disappearance of 100 million trees in the U.S. (due to the beetle known as the emerald ash borer) was linked to over 20,000 fatalities from cardiovascular and lower respiratory illnesses in 15 states. The detection of a quarantine pathogen on a few infected plants could cause immediate border closures for exports, threatening multi-billion dollar markets.

One example of a plant pathogen is the fungus Synchytrium endobioticum, which causes potato wart disease. The spores of the fungus can survive in the soil for 20 years or longer, making it very difficult to eradicate. Potatoes with the disease are safe to eat, but are so deformed that they are unmarketable. This fungus has been causing problems for a long time. In the early 1900s, potato wart was detected on the island of Newfoundland. Since then, there has been a complete ban on their potato exportations, and extensive measures were put in place to prevent the spread to other provinces and countries.

More recently in 2000, a few potatoes infected with potato wart were found for the first time in a small corner of a Prince Edward Island (P.E.I.) field, leading the U.S. to stop importations of potatoes from that province.

According to the Auditor General of Canada, this caused close to $100 million in losses in the few months this embargo was enforced. Still today, this pathogen is on the U.S. “Select Agent List”, along with human and animal pathogens such as the Ebola virus and the causal agent of foot and mouth disease of animals.

There has been great progress made in the development of detection tools to enhance food safety and protect Canada’s agri-food system. One project, funded through the former Chemical, Biological, Radiological-Nuclear and Explosives Research and Technology Initiative (CRTI) in 2004, brought together Agriculture and Agri-Food Canada (AAFC), the Canadian Food Inspection Agency (CFIA), and the Canadian Forestry Service of Natural Resources Canada to develop detection tools for several high risk plant pathogens, including Synchytrium endobioticum. This led to the development of a rapid DNA test to detect very low numbers of pathogen spores directly from the soil. The test has been validated and published in the journal Phytopathology - one of the best international journals for plant pathology - and is used by the CFIA to quickly confirm the presence of potato wart spores and prevent its spread.

All life forms have a genome made of DNA, which contains their genetic information. Approximately 15 years ago, it took about ten years and $3 billion to complete the DNA sequencing of the first human genome. Today, it only takes a few days and about $1,000; a price drop at a magnitude and speed unprecedented in life science technologies.

In 2011, AAFC, the CFIA and the Canadian Grain Commission (CGC) embarked on a new collaborative CRTI project to capitalize on this transformative change in DNA sequencing technology. Several high-risk plant pathogens primarily found on cereal and potato crops were targeted. Sequencing the complete genome of Synchytrium endobioticum was difficult because pure DNA is very difficult to obtain as the pathogen can only grow on potato plants and large amounts of DNA are still needed for complete genome sequencing. While working in collaboration with the Plant Research International institute in the Netherlands, the scientists involved in this project succeeded in sequencing the pathogen’s genome. From this data, they were able to identify microsatellites to differentiate individual strains of the pathogen, much like the approach used to match DNA from a crime scene to a suspect or determine family relationship between two people.

During this project, new fields with potato wart were reported in P.E.I. and scientists were able to use this new microsatellite test to map the genotypes, i.e. the similarities between Canadian and European samples received from the Dutch colleagues. The test developed through this project can be used to generate the genotype profile of any new sample found in Canada from very little DNA, providing forensic-like information that is highly valuable to the CFIA and potato industry stakeholders as they protect crops and conduct trade.

"This work is very important to our industry," said Greg Donald, General Manager of the Prince Edward Island Potato Board. "We commend AAFC and CFIA for approaching Defence Research and Development Canada’s Centre for Security Science’s (DRDC CSS), the CRTI and Canadian Safety and Security Program (CSSP) for recognizing and responding to the economic and biosecurity threat posed by the disease in Canada and around the world. Our industry was devastated when the U.S. border was closed to us for six months of our main shipping season after the discovery of potato wart in a corner of one potato field.”

“Since then, CFIA has developed a long term management plan for potato wart, and we have continued to access all key markets,” continued Mr. Donald. “Being able to identify strains/pathotypes quickly and accurately has many potential benefits to the Canadian and global potato industries, including potentially being able to screen varieties much more rapidly for resistance and susceptibility to the strain involved. We look forward to learning more as this work progresses."

C. André Lévesque is a Research Scientist (Mycology) with Agriculture and Agri-Food Canada.